IHI National Forum Defining Moments

Transcription

1 IHI National Forum Defining Moments Achieving Excellence and Reliability Baldrige Performance Excellence Program December 2012 Faculty Craig Deao: R&D Leader, The Studer Group Joel Ettinger: President, Category One Inc. Josh Ettinger EVP Category One Inc. and President, Magellan Institute Susan Hawkins: SVP Performance Excellence, Henry Ford Health System 1

2 Experience Objectives Introduce a Framework for organizational excellence Assess, compare, performance against Baldrige role models Redefine excellence Describe how the Framework creates inspired cultures and immediately improving performance What Will NOT Happen You will not understand all of it it s too big We will not address all elements of the Framework equally it s too big Know everything you need to do when return to your worksite and colleagues it s too big 2

3 Criteria for Performance Excellence Business Health Care Education A disciplined approach to addressing key patient/customer, stakeholder, and operational requirements integrating cycles of refinement and innovation How Do You/We Know That Effective leadership system is in place that assures sustainability, excellence, agility, relentless patient focus even in economically difficult times Pervasive innovation is a key differentiator Strategic planning process produces appropriate stretch targets fully deployed 3

4 How Do You/We Know That Market data are valid/segmented to design/deliver products/services that people want/need The people we serve can easily access services Accurate satisfaction, loyalty, referral, & engagement determination systems exist Information systems are based on user needs and produce actionable information How Do You/We Know That Everyone has the knowledge they need to have to make healthcare great Culture is optimal, work systems carefully designed, necessary skills secured, all workforce is proud, recognized, loyal, engaged New services are designed systematically with patient/customer, evidence-based input 4

5 How Do You/We Know That We provide, always, the finest error free medicine humanly possible We out-compete the competition in all important ways care experience and research funding Our clinicians are magnificent members of the an amazing workforce that makes the health care All major processes are continually improved, waste eliminated everywhere How Do You/We Know That All key results based on Critical Success Factors are measured, trended, compared to competition and best-in-industry The approaches to work and improvement, and innovation are systematic, deployed and aligned on an enterprise-wide basis 5

6 These Things Happen, No Longer The Baldrige Performance Excellence Program What are the Criteria? The leading edge of validated management practice 6

7 What are the Criteria? Expectations or requirements Structured approach to improvement Framework for a systems view of performance management Based upon a set of core values A common language Criteria Purposes Alignment of key components Go beyond conformance-to-standard to a focus on excellence Facilitate communication and sharing among all types of organizations Working tool for understanding and managing performance improvement 7

8 Criteria Key Characteristics Focus on results Are non-prescriptive and adaptable Support a systems perspective Support goal-based diagnosis THE FRAMEWORK 8

9 Four Harmonized Components Simplified Organizational Profile Who are we? What is important to us? Core Values What do we believe in? Criteria How do we do it Performance Differentiators How well are we doing it? (results) CORE VALUES/CONCEPTS Visionary Leadership Patient-focused Excellence Organizational and Personal Learning Valuing Workforce Members and Partners Agility Focus on the Future Managing for Innovation Management by Fact Social Responsibility and Community Health Focus on Results and Creating Value Systems Perspective CORE COMPETENCIES BALDRIGE: The Pursuit of Excellence FEELING, THINKING, BEING, THEN DOING EVERY, EVERY, EVERY HOW DOES INNOVATION DISTINGUISH US WHAT ARE YOU THINKING HOW DO YOU KNOW EMPOWERMENT SO WHAT ORG PROFILE & 7 CATEGORIES OF CRITERIA PERFORMANCE DIFFERENTIATORS (ADLI) How are our APPROACHES SYSTEMATIC? How are our approaches fully DEPLOYED? How does LEARNING and IMPROVEMENT happen? SEGMENTATION ENGAGEMENT How is our work ALIGNED and INTEGRATED? 9

10 The Comprehensive Excellence Continuum Right to Operate CMS/State Surveys Maintain Right to Operate JCAHO CMS/State Surveys DNV Improvement Maintain Magnet JCAHO DNV Improvement Magnet TPS & Six Sigma TPS & Six Sigma Innovation Innova on Org Excellence Org Excellence Other Govt. Surveys ISO9000 Other Govt. Surveys ISO9000 HFAP TQM HFAP TQM MI MI Compliance/QA/QC Driven Leadership/Customer Driven SG s Best Practices Specific and interdependent practices that have value to all businesses to create better places to work & higher quality services for customers. Objective Evaluation System Leader Development Must Haves Performance Gap Standardization Accelerators Accelerators Aligned Goals Aligned Behavior Aligned Process Leader Evaluation Process Goal Cascade Monthly Meeting Model 90-day Plans Linkage grids LDI CDI Peer Interviewing 30/90 day meetings AIDET Managing Up highmiddlelow Performer Conversations Rounding on Employees Leader Rounding for Outcomes Hourly Rounding Pre- and Post-Visit Calls Pillar Framework 6-month EBL assessments LEM Stoplight Report Support Service Survey PCM SG Portal RED Strategy Planning Process Virtual Tokens of Recognition Service Guarantee 10

11 World Class Quality The most comprehensive list of actions to achieve world-class quality is contained in the Malcolm Baldrige Criteria. Joseph Juran Quality Progress August, 1994 Respondents Who Used the Criteria Quality Progress Percent Answering Source of information on business excellence To improve existing processes departmentwide To communicate with others inside a company Part of a course or seminar curriculum For informal self-assessment departmentwide To improve existing processes companywide For written self-assessment departmentwide To set up quality processes departmentwide For written self-assessment companywide For informal self-assessment companywide To set up quality processes companywide To communicate with business partners To communicate with other companies To apply for an award To communicate with the public sector

12 The Framework Effectively Enables Sustainability Innovation An engaged workforce Significantly greater integrated physician relationship Proactively address the more knowledgeable customer The Baldrige Effect Reduce cost, waste, errors Less work, Better Work, More Accomplished Silos replaced by system integration and collaboration To better manage the future health care reform, ACOs, declining reimbursement Improved performance in all key results 12

13 The Baldrige Effect It creates the culture and context to EXECUTE and FULLY DEPLOY Best Practices and, preferably Better Than Best Practices Intelligent Risk and Innovation 2012 Award Recipients Lockheed Martin Missiles and Fire Control, Grand Prairie TX Mesa Products, Tulsa OK North Mississippi Health Services City of Irving 13

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17 Manufacturing Award Recipients 3M Dental Division (1997) Armstrong Building Products Operations (1995) Boeing Airlift & Tanker Programs (1998) Cargill Corn Mill (2008) Clarke American Checks, Inc. (2001) Corning Telecommunications Products Division (1995) Eastman Chemical (1993) Honeywell Federal Manufacturing Technologies (2008) IBM Rochester (1990) Lockheed Martin Missiles and Fire Control (2012) Medrad (2003, 2010) 17

18 Manufacturing Award Recipients Milliken & Company (1989) Motorola CGISS (2002) Motorola, Inc. (1988) Nestle Purina Petcare (2010) Solar Turbines Inc. (1998) Solectron Corporation (1991 and 1997) Sunny Fresh Foods (1999, 2005) STMicroelectronics -- Region Americas (1999) Texas Instruments Defense Systems & Electronics (1992) Westinghouse Commercial Nuclear Fuel Division (1988) Xerox Business Products & Systems (1989) Service Award Recipients BI (1999) Boeing Aerospace Support (2003) Caterpillar Financial Services U.S. (2003) DynMcDermott Petroleum Operations (2005) Federal Express Corporation (1990) Merrill Lynch Credit Corporation (1997) Operations Management International, Inc. (2000) Premier, Inc. (2006) The Ritz-Carlton Hotel Company, L.L.C. (1992 and 1999) Xerox Business Services (1997) GTE Directories Corporation (1994) 18

19 Small Business Award Recipients Branch-Smith Printing Division (2002) Freese and Nichols (2010) Granite Rock Company (1992) Los Alamos National Bank (2000) Mesa Products, Inc. (2006, 2012) Midway USA (2009) Pal s Sudden Service (2001) K&N Management (2010) Park Place Lexus (2005) PRO-TEC Coating (2007) Stoner, Inc. (2003) The Studer Group (2010) Texas Nameplate (1998, 2004) Trident Precision Manufacturing, Inc. (1996) Education Award Recipients Chugach School District (2001) Community Consolidated School District 15 (2003) Iredell-Statesville Schools (2008) Jenks Public Schools (2005) Monfort College of Business (2004) Montgomery City Schools (2010) Pearl River School District (2001) Richland College (2005) University of Wisconsin-Stout (2001) 19

20 Non-Profit Award Recipients City of Coral Gables (2007) City of Irving (2012) Concordia Publishing House (2011) US Army Armament Research, Development and Engineering Center (2007) VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (2009) Health Care Award Recipients Advocate Good Samaritan Hospital (2010) AtlantiCare (2008) Baptist Hospital, Inc. (2003) Bronson Methodist Hospital (2005) Heartland Health (2008) Henry Ford Health System (2011) Mercy Health System (2007) Poudre Valley Health System (2008) North Mississippi Medical Center (2006) North Mississippi Health Services (2012) Robert Wood Johnson (2004) St Luke s Hospital (2003) Sharp HealthCare (2007) SSM Health Care (2002) Schneck Medical Center (2011) Southcentral Foundation(2011) 20

21 When are you too busy to pursue excellence? CORE VALUES/CONCEPTS Visionary Leadership Patient-focused Excellence Organizational and Personal Learning Valuing Workforce Members and Partners Agility Focus on the Future Managing for Innovation Management by Fact Social Responsibility and Community Health Focus on Results and Creating Value Systems Perspective CORE COMPETENCIES BALDRIGE: The Pursuit of Excellence FEELING, THINKING, BEING, THEN DOING EVERY, EVERY, EVERY HOW DOES INNOVATION DISTINGUISH US WHAT ARE YOU THINKING HOW DO YOU KNOW EMPOWERMENT SO WHAT ORG PROFILE & 7 CATEGORIES OF CRITERIA PERFORMANCE DIFFERENTIATORS (ADLI) How are our APPROACHES SYSTEMATIC? How are our approaches fully DEPLOYED? How does LEARNING and IMPROVEMENT happen? SEGMENTATION ENGAGEMENT How is our work ALIGNED and INTEGRATED? 21

22 ORGANIZATIONAL PROFILE Who are we? Organizational Profile What s important to us? What do our customers want? What does our workforce need? What are we really good at? What are our challenges and advantages? 22

23 PERFORMANCE DIFFERENTIATORS Characteristics of Great Companies Know the right things to do Do the right things Do the right things well Do the right things well ALL THE TIME. 23

24 Performance Differentiators Approach/Deployment 1. Approach--Systematic Approaches are repeatable Use data/information to enable evaluation, learning and improvement 2. Deployment--Full Extent to which systematic approaches are used by all appropriate work units 3. Learning/Improvement Ongoing Cycles Evidence of fact-based systematic evaluation and improvement Organizational learning important to the achievement of critical success factors 4. Integration and Alignment Integration of plans, processes, information, resources, actions, results, analysis and learning throughout the organization Approach and Deployment Approach A method or process Steps Ownership Repeatability (systematic) Deployment The approach is disseminated to all places and people The approach includes and/or considers all segments What is your systematic approach to deployment? 24

25 Learning, Alignment, and Integration Learning / Refinement Is the process effective? How do you know? What measures do you review? When are they reviewed? What is your systematic approach to learning, improvement, and innovation for this process? Alignment / Integration Do our systems and processes support and/or reinforce what matters? Do our systems and processes appropriately and effectively work together Results: Performance Differentiators Current good or excellent results Results trended > three years show improving trends Trended results compared to industry performance are at least good Trended results are best-in-industry, world-class 25

26 Scoring Band Information Band Band Number Descriptors Early stages of developing and implementing approaches to Category requirements. Important gaps exist in most categories Beginning of a systematic approach to the primary purposes of the Items, but major gaps exist in approach and deployment in some Categories. Early stages of obtaining results stemming from approaches A systematic approach to the primary purposes of most Items, but deployment in some key Areas to Address is still too early to demonstrate results. Early improvement trends in some areas of importance to key requirements. Effective approaches to many Areas to Address, but deployment in some Areas is still at early stages. Further deployment, measures and results are needed to demonstrate integration, continuity and maturity. Scoring Band Information Band Band Number Descriptors A sound, systematic approach responsive to many of the Areas to Address with a fact-based improvement process in place in key areas. No major gaps in deployment, and a commitment to organizational analysis and learning. Improvement trends and/or good performance reported for most areas of importance. Refined approaches, including key measures, good deployment and good results in most Areas. Some outstanding activities and results clearly demonstrated. Good evidence of continuity and maturity in many Areas. Basis for further deployment and integration is in place, with a focus on industry analysis, learning and sharing of best practices. May be industry leaders or benchmark leaders in some Areas Refined approaches, excellent deployment, and good to excellent improvement and levels demonstrated in most Areas. Good to excellent integration, with analysis. Learning, and sharing of best practices as key management strategies. Industry leadership and some benchmark leadership Outstanding approaches, full deployment, excellent and sustained results. Excellent integration and maturity, with analysis, learning and sharing of best practices pervasive. National and world leadership. 26

27 Results Category One, Inc. Year 5 QV Scores Rank Business Unit Score 1 Pacific Guidance & Navigation Op Sensing & Control NA Solid State Electronics Center Space Systems Industrial Automation & NA Defense Avionics Systems Business & Computer Sys Motion & Sensor Products Ops Europe Space & Aviation Control Transport Systems Satellite Systems Ops Europe Ind Auto & Control Europe Europe Sensing & Control Europe BC Solutions & Services Europe BC Products Technology Center Southeast Asia BC Products NA BC Solutions & Services NA Latin America China Area

28 Industrial Automation and ( ) US Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5 Total Points: Leadership 1.1 Leadership System 70% 1.2 Company Responsibility & Citizenship 60% 2.0 Strategic Planning 2.1 Strategy Development Process 70% 2.2 Company Strategy 60% 3.0 Customer & Market Focus 3.1 Customer & Market Knowledge 65% 3.2 Customer Satisfaction & Relationship Enhancement 70% 4.0 Information and Analysis 4.1 Selection & use of Information & Data 70% 4.2 Selection & Use of Comparative Information & Data 55% 4.3 Analysis & Review of Company Performance 50% 5.0 Human Resource Focus 5.1 Work Systems 70% 5.2 Employee Education, Training & Development 60% 5.3 Employee Well-Being & Satisfaction 65% 6.0 Process Management 6.1 Management of Product & Service Processes 65% 6.2 Management of Support Processes 55% 6.3 Management of Supplier & Partnering Processes 70% 7.0 Business Results 7.1 Customer Satisfaction Results 58% 7.2 Financial & Market Results 60% 7.3 Human Resource Results 55% 7.4 Supplier & Partner Results 65% 7.5 Company-Specific Results 52% ( ) Technology Center Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5 Total Points: Leadership 1.1 Leadership System 48% 1.2 Company Responsibility & Citizenship 45% 2.0 Strategic Planning 2.1 Strategy Development Process 50% 2.2 Company Strategy 38% 3.0 Customer & Market Focus 3.1 Customer & Market Knowledge 40% 3.2 Customer Satisfaction & Relationship Enhancement 37% 4.0 Information & Analysis 4.1 Selection & use of Information & Data 44% 4.2 Selection & Use of Comparative Information & Data 35% 4.3 Analysis & Review of Company Performance 45% 5.0 Human Resource Focus 5.1 Work Systems 50% 5.2 Employee Education, Training & Development 50% 5.3 Employee Well-Being & Satisfaction 55% 6.0 Process Management 6.1 Management of Product & Service Processes 49% 6.2 Management of Support Processes 50% 6.3 Management of Supplier & Partnering Processes 40% 7.0 Business Results 7.1 Customer Satisfaction Results 44% 7.2 Financial & Market Results 46% 7.3 Human Resource Results 45% 7.4 Supplier & Partner Results 40% 7.5 Company-Specific Results 45% 28

29 Return on Investment QV Score (Avg.) QV Score 12/9/ Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5 Year Year 29

30 Operating Profit Rate Earnings Per Share QV Score QV Score 12/9/ Year Year 0 30

31 Return on Equity Economic Value Added ($M) QV Score QV Score 12/9/ Year Year

32 Sales Per Employee ($K) Controlled Working Capital (% of Sales) QV Score QV Score 12/9/ Year Year 32

33 Year 4 to Year 5 Progress st Year Applicant Scoring Range of Baldrige site-visited Companies When it comes to Culture and Excellence Do or do not. There is no try. Yoda 33

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36 % of Patients 12/9/2013 Saint Luke s Hospital Percent of Patients Diagnosed with Ischemic Stroke Receiving tpa SLH National Average Next Best BETTER Year 1 Year 2 Year 3 Year 4 Year 5 Sustained Performance Greater Efficiencies 36

37 % of Patients 12/9/2013 Sustained Clinical Performance Improving Productivity SLH National Average Next Best Saint Luke s Hospital Percent of Patients Diagnosed with Ischemic Stroke Receiving tpa BETTER

38 Percent 6.9% Decrease % Decrease 95 12/9/2013 Transforming the Patient Experience: Patient Satisfaction Results - Percentile (Press Ganey) Outpatient Inpatient Emergency Amb Surg Conv Care Q Results of Stakeholder Loyalty GSAM Market Share For Overlapping Markets (Overall IP) 25% 20% 20.5% 20.0% 21.4% 23.1% 23.4% 17.0% Increase 7.4% Decrease 15% 25.6% Decrease 10% 5% 0% G S A M H o s p A H o s p B H o s p C H o s p D Source: CompData KAPE Q

39 Q1 96 Q3 96 Q1 97 Q3 97 Q1 98 Q3 98 Q1 99 Q3 99 Q1 00 Q3 00 Q1 01 Q3 01 Q1 02 Q3 02 Q1 03 Q3 03 Q1 04 Q3 04 Q1 05 Q /9/2013 Inpatient Satisfaction 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q1 95 Q3 95 Q1 96 Q3 96 Q1 97 Q3 97 Q1 98 Q3 98 Q1 99 Q3 99 Q1 00 Q3 00 Q1 01 Q3 01 Q1 02 Q3 02 Q1 03 Q3 03 Q1 04 Q3 04 Q1 05 Q3 05 Baptist Percentile Gulf Breeze Percentile Outpatient Satisfaction 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Baptist Percentile BMP Percentile 39

40 Q1 96 Q3 96 Q1 97 Q3 97 Q1 98 Q3 98 Q1 99 Q3 99 Q1 00 Q3 00 Q1 01 Q3 01 Q1 02 Q3 02 Q1 03 Q3 03 Q1 04 Q3 04 Q1 05 Q /9/2013 Ambulatory Satisfaction 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q1 97 Q3 97 Q1 98 Q3 98 Q1 99 Q3 99 Q1 00 Q3 00 Q1 01 Q3 01 Q1 02 Q3 02 Q1 03 Q3 03 Q1 04 Q3 04 Q1 05 Q3 05 Baptist Percentile BMP Percentile Gulf Breeze Percentile Emergency Department Satisfaction Baptist Percentile Gulf Breeze Percentile 40

41 Home Health Satisfaction 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Q4 97 Q1 98 Q2 98 Q3 98 Q4 98 Q1 99 Q2 Q Q4 99 Q1 00 Q2 00 Q3 00 Q4 00 Q1 01 Q2 Q Q4 01 Q1 02 Q2 Q Q1 03 Q2 Q Q4 03 Q1 04 Q2 04 Q3 04 Q4 04 Q1 05 Q2 Q Baptist Percentile Patient Satisfaction Starts With Employee Satisfaction Q1 96 Q3 96 Q1 97 Q3 97 Q1 98 Q3 98 Q1 99 BH Patient %-tile Q3 99 Q1 00 Q3 00 BH Employee Morale Q1 01 Q3 01 Q1 02 Q3 02 Q1 03 Q

42 Customer-Focused Outcomes - HCAHPS Customer-Focused Outcomes Top Box Scores for Patient Satisfaction 8 years of consistent improvement 42

43 Rate of Change: SG Partners Improve Where Others Decline Bronson Memorial Hospital: RN Turnover 20% 15% Good 14.6% 10% 5% 12.9% 5.4% 0% YTD BMH National Benchmark Best Practices National Benchmark Source for National Benchmark: NACHR - JWT Source for Best Practice: ANCC 43

44 Workforce-Focused Outcomes Staff Voluntary Turnover Workforce-Focused Outcomes Physician Engagement Scorecard 44

45 Percentile Good 12/9/2013 Physician Engagement and Relationship Physician Engagement Survey Results Source: HealthStream Top Decile NMMC Results Key Process Measures Customer Satisfaction Press Ganey 501+ beds Measure Employees Physicians Patients Percentile 93 rd 99 th 90 th 45

46 $ Millions # Days 12/9/2013 Saint Luke s Hospital 70 Net Days in Accounts Receivable BETTER SLH COTH Top Quartile A-Bond *SLH data represents best 5% of comparative group * NMMC Results Care-Based Cost Management: Making the Business Case for Quality Cumulative financial gains from outcomes management of focused DRG losers

47 Minutes 12/9/2013 Saint Luke s Hospital Admitting Wait Time IP BETTER Patient Type Year 1 Year 2 Year 3 Year 4 OP Financial & Market Outcomes Patient Discharges: 50% increase since 1 st Baldrige application 50% increase in PVHS discharges from 2000 to % population growth in Larimer County from 2000 to % increase in Competitor discharges from 2000 to % population growth in Competitor s home county from 2000 to

48 Remaining Competitive Hospital Charges NMMC Results Key Process Measures Efficiency/Finance Solucient 501+ bed, Case Mix Adjusted Measure FTE s Total Labor Expense Charges per Discharge Operating Margin Total Margin Percentile 14 th 9 th 8 th 90 th 95 th 48

49 2005 Medicare per Capita Spending by Hospital Referral Region Dartmouth Atlas data When are you too busy to pursue excellence? 49

50 Category One Inc. Redefining Excellence Joel H. Ettinger Josh H. Ettinger